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The prostate is a small structure with the size and shape of a walnut, found closely attached to the urethra (where urine passes out the male sex organ). It secretes part of the semen that is ejaculated during sexual intercourse.
Malignant neoplasm of the prostate is a cancerous new growth that occurs mostly in elderly mean, with a mean age of 72. It is the most common malignancy in males, and the third most common cause of their death from cancer. It is seldom diagnosed in men younger than the age of 40. More African-Americans are afflicted than whites, and those with a family history of the disease are more likely to have it.
Some factors have been linked to prostate cancer such as obesity, cigarette smoking, alcohol abuse, high animal fat intake and exposure to cadmium and agent orange chemicals. Farmers, painters and tire plant workers are also prone to acquire the malignancy. Recent studies have shown that a history of sexually transmitted disease can predispose one to prostate cancer.
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Initially the tumor may exist for a number of years without causing any symptoms. However, as it grows larger, it can press on the urethra and cause symptoms related to urination that may lead the patient to seek consultation. Symptoms of prostate cancer include:
- Difficulty in emptying the bladder completely
- Dribbling, or dripping of urine after urination
- Slow stream of urination
- Delayed or slow start in urination
- Blood in the urine
- Blood in the semen
Sometimes the above symptoms are not severe enough to prompt the patient to seek medical help. In late stages, when the cancer cells have spread or metastasized to other body parts, these symptoms may include:
- Low back or pelvic pain – due to bone metastasis
- Abdominal pain and yellowing of skin – due to liver metastasis
- Coughing and chest pain - spread of cancer cells to the lungs
- Seizures, headaches – signals brain involvement
- Weight loss and fatigue
It may be noted that most prostate tumors are slow growing and many patients live long and die of other causes or diseases; the tumor may even be found only at autopsy.
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Malignancies in the prostate may be initially detected by routine physical examination when the doctor does a digital rectal examination. The doctor will feel an enlarged prostate that is firm or hard. Sometimes it may also be initially detected through routine blood screening for prostate-specific antigen (PSA).
Since signs and symptoms and even lab exams may resemble other conditions of the prostate such as benign prostatic hyperplasia (BPH) and prostatitis, prostate cancer can be diagnosed definitively by doing a needle biopsy.
To find out if other organs have been involved by the possible spread of cancer, CT scans and bone scans may be done.
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There are many treatment options for malignant neoplasms of the prostate. Since it is a slow growing tumor, if it is found in the elderly, the doctor may opt to just observe the patient and monitor PSA levels instead of doing any aggressive measures.
In younger patients treatment will depend on the stage of the disease. Those in early stages have the following options:
- Radiation therapy, of which there are three possible types:
- External beam radiation –uses high powered x-ray beams
- Prostate brachytherapy – involves implantation of radioactive seeds in the prostate
- Proton therapy – proton beams are aimed on the tumor, avoiding exposure of other parts of the body
- Surgery – involves radical prostatectomy, which may be done through an open procedure to remove the tumor, or by using minimally invasive robotic surgery
- Hormone Therapy – aims to decrease the body’s level of testosterone, a male hormone that induces growth of the tumor
- Chemotherapy and Immunotherapy – medications used to treat malignancies that have spread and are unresponsive to other forms of treatment
Complications of these therapeutic modalities include impotence, difficulty in controlling urination and bowel problems.
Serial measurements of PSA may be done to monitor cure or recurrence of the cancer. Prognosis of treatment depends on the stage of diagnosis and the general health of the patient.
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MedicineNet, “Prostate Cancer", accessed 1/23/11
WebMD, “Prostate Cancer Treatment - Treatment Option Overview" accessed 1/23/11